Do You Really Need a PSA Test?

For decades, men have dutifully shown up at their doctor’s office sometime around their 50th birthday for a baseline PSA (prostate-specific antigen test). As PSA levels rise, the theory went, so do your odds of having prostate cancer.

But now, the U.S. Preventive Services Task Force (USPSTF)—the same group of medical experts who made 2009 headlines by proposing that women under age 50 forego mammograms—has drafted a recommendation that men no longer receive the PSA test. The new recommendation applies to men both with and without risk factors, such as being of African-American heritage or having a family history of prostate cancer.

The prostate cancer death rate has dropped since PSAs became common in the early 90s, but it’s unclear whether this drop is a direct result of screening or due to improvements in treatment.

Problems with the PSA Test

“PSA screening for early detection of prostate cancer has more harms than benefits,” USPSTF co-vice chair Michael LeFevre, M.D., a professor of family and community medicine at the University of Missouri, told MensHealth.com.

The risk for false-positives looms large: PSA levels can increase due to an enlarged or inflamed prostate—both benign conditions. According to the American Cancer Society, only 25 to 35 percent of men who have a biopsy due to an elevated PSA level actually have prostate cancer. And unnecessary biopsies are needlessly invasive, expensive, and carry an acute risk of prostate infection in about 1 percent of patients. There is also the risk of temporary problems using the bathroom. (Click here for 5 Do-It-Yourself Medical Tests that really work.)

More Testing Leads to Unnecessary Treatment

“Most prostate cancers are not fast growing and many men are being treated for cancers that would never cause them harm,” Dr. LeFevre says. Otis W. Brawley, M.D., chief medical officer of the American Cancer Society, noted earlier this year, “[Many prostate cancers] are cured, but do not need to be cured.”

Then there are the undesirable treatment side effects: Dr. LeFevre says that for every 1,000 men surgically treated for prostate cancer, 200 to 300 will suffer urinary incontinence, impotence or both; 10 to 70 will experience serious post-operative complications and five will die within 30 days from complications. To read one man’s account of life after prostate cancer surgery, read the National Magazine Award–winning story I Want My Prostate Back.

Urologists Push Back for Routine PSA Testing

Scores of urological experts, however, including the American Urological Association, challenge the USPTSF’s assertion.

“Yes, it is an imperfect test: A lot of men have prostate cancer diagnosed that’s not particularly threatening, and a third of prostate cancers grow so slowly that men are destined to die of something else first,” admits Christopher Kane, M.D., chief of the Division of Urology and professor of surgery with the UC-San Diego School of Medicine. “But we need to help patients make personalized decisions based on their age, health, and the aggressiveness of the cancer.”

For example, an 80-year-old man should rarely be treated, Kane says, but a 50-year-old with an intermediate grade tumor likely should. A younger man with a slow-growing cancer may be safely followed without treatment but with the understanding that if it becomes more aggressive, it will require intervention. That said, a PSA test and biopsy is the only currently available method of determining who is in what camp.

LeFevre says that men experiencing symptoms such as difficulty urinating, or frequent urination at night should consult their physician. But Men’s Health advisor and Baylor College of Medicine urologist Larry Lipshultz, M.D., notes that 99.9 percent of prostate cancer is silent.

More from MensHealth.com: Prostate Cancer Symptoms

What Should You Do?

Lipshultz says he will continue to recommend his patients undergo a baseline PSA at age 50 (40 if high risk), keeping in mind that “just because your first PSA test is elevated does not necessarily mean you have cancer.” Depending on your levels, your physician will repeat your PSA every six months to distinguish a false positive from an upward trend.

Kane, too, advocates continued screening but an increasing selectivity with treatment, seeking a urology referral for an abnormal PSA test to discuss your options.

The bottom line, our experts say: Have the PSA test. But don’t assume prostate cancer must be treated.

There’s hope on the horizon, too. Kane adds that improved, non-invasive diagnostic tests, including molecular analyses to determine the severity of the cancer without surgery, should be widely available in a few years.

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